Medical Experience in India - Essay Example

?My Work Experience in India Sri Guru Ram Das My medical career began at the Sri Guru Ram Das Charitable Hospital in Amristar, India. I worked with their highly skilled medical staff as an Emergency Medical Officer from April 2000 to December 2001. As the head of the emergency department, I was tasked with the task of overseeing and coordinating clinically appropriate and safe assessments and treatments of the emergency room patients. I will never forget my most memorable emergency case to date at this hospital. An elderly lady in her late 70's came into our emergency room complaining of a high grade fever, nausea, diarrhea, bloody vomiting, and cramping abdominal pain. A preliminary interview showed that she had been suffering the symptoms for almost 5 consecutive days already and she was taking Maalox to remove her stomach pain and nausea alongside Imodium to help ease the effects of diarrhea. However, the medications were not having any effect on her and she could no longer hold down the water that she was being made to drink. Her skin was obviously suffering from effects of dehydration and she was unable to keep her food down. As we awaited the results of the blood test I ordered, she began to suffer a severe headache, muscle pains, and difficulty breathing. The additional symptoms made me suspect she was maybe suffering from Gastroenteritis. As with other possible cases of Gastroenteritis, I thought it best to trace the history of the foods that she had consumed over the past few days. She mentioned that she ate chicken that seemed a little bit undercooked to her. I immediately suspected that she could have ingested the Salmonella virus that is borne by undercooked poultry. I ordered a CBC, electrolytes, and kidney function test to be performed upon her. The blood test and stool sample I had collected confirmed that she indeed was battling the Salmonella virus in her system. I ordered her immediate admission into the hospital and hooked her up to IV fluids to help ease the effects of dehydration and placed her on a soft-bland solid diet in small amounts to help increase her strength. I ordered her fluid intake to be monitored and her stool regularly tested for the existence of salmonella. I prescribed promethazine to control the nausea, continued the loperamide treatment for diarrhea, and controlled amounts of clear liquids while we brought up her electrolytes to the normal level. As with all cases of Gastroenteritis, her system would have to flush out the toxins on its own. My main concern, was that she did not progress from her current state of dehydration in order to avoid future complications to her healing process. She was cleared to go home after a few days stay at the hospital. On the office side, I felt that there was a lot of work to be done in order to keep the administrative side in order and to make sure that our emergency room records were always kept in an organized and logical manner. That is why I divided our office into various teams with specific tasks. I created a team whose sole responsibility was the study of local pharmacies. This team in turn, coordinated with the team that represented our hospital with the drug manufacturers and blood banks in order to assure or hospital of top of the line and uncontaminated pharmaceutical supplies. Anand Hospital I worked at Anand Hospital and Heart Care Center also in Amritsar from from June 2000 to May 2002 as a Medical Officer. I felt a need to make sure that the people who walked into our emergency room would leave better educated their medical needs. So I under took the printing of pamphlets and leaflets that could help our walk in patients better understand their medical needs and requirements. One of the main difficulties that I had in treating the emergency room patients in this particular hospital was the lack of proper medical diagnostic tools. I had to rely on primitive X-rays rather than sophisticated MRI or CT scans in order to treat my patients who came in with possible concussions. This particular hospital helped me learn how to diagnose by observation and symptoms rather than by modern technological methods. I remember in one particular instance, I had a patient of around 80 years old brought in to the emergency room. by his eldest daughter. She was requesting to have her father admitted to our psychiatric ward as soon as possible because he was going crazy. I told her that I could not just admit her father to that particular ward until I had properly diagnosed and assessed his situation. I asked her to leave the man at our hospital for a 2 day observation period instead. During this time, I took a personal interest in this case. Mostly because of the rising incidence of elder abuse in India. Then I observed that he was not exhibiting signs of going crazy but rather, he was suffering from the effects of repeated concussions. His symptoms included not being able to think clearly, he was unable to concentrate and remember new information, fuzzy vision, sensitivity to light and noise, balance problems, he was also easily upset or angered and was constantly nervous or anxious. All of which were classic symptoms of a concussion. It was after hearing these symptoms that I checked for possible a hematoma's around his skull. Having found the “goose eggs” or bleeding under the scalp but outside the skull, I telephoned his daughter and asked her to pick up her father. Since I did not find any cuts on his head, I advised her to simply take him back home and apply ice to his injuries. I pointed out the specific swollen spots in his head and explained the home treatment of a concussion to her. I assured her that her father was not going insane and he would be fine in a few days provided they let him have ample bed rest. It was this gift of diagnosing patients using limited equipment that earned me the admiration of my fellow doctors at the hospital. Gulab Devi From there I ended up working from October 2002 to October 2006 at the Gulab Devi Hospital in Jalandhar, India as a Resident Medical Officer. I treated various types of people on this job and each case became more interesting than the last. There was one specific day when my job brought me to the realization of how badly the carbon monoxide poisoning in India was becoming. In one day, I had 20 patients come in who all shared the same signs and symptoms of illnesses. Each of them were experiencing either a few or all of the same symptoms that included but wasn't limited to headaches, dizziness, chest pain, vomiting, fainting, with other flu-like symptoms. The first thing I wanted to rule out, given the state of air pollution in India was carbon monoxide poisoning. I did this by ordering a blood test that looked at the oxygen level in their blood. Majority of the patients all suffered from the same low levels of oxygen in their blood. The others also displayed shortness of breath on exertion, confusion, hallucination, vomiting, drowsiness, and an assortment of other symptoms. Suspecting that they were all suffering from Carbon Monoxide Poisoning, I immediately ordered the patients be placed on oxygen until they recovered and then releasing them via the out patient department. It was of the utmost importance that our staff monitored the carbon monoxide level in their blood as their symptoms began to subside. However, there were a few patients whose poisoning was so severe that I had no choice but to have them sent to a neighboring hospital that had a hyperbaric pressure chamber in order to treat them. I was commended by the hospital administration for my excellent work in handling what at the time they thought was an emerging viral epidemic in our area. Whenever called upon, I also arranged for medical evacuations, air evacuations, and looked into validity and truthfulness of medical clearances issued by our doctors. Additionally, my other administrative work included clearance decisions, coordinating with higher administration officers and an emergency action committee whenever necessary. I also helped choose medical advisers for the hospital based on statistical reports. Due to the new orientation that this particular job offered me, I found myself becoming increasingly interested in participating in clinical trials. Thanks to my track record of excellent service and work ethics with all the hospitals that I worked with, I was given the privilege of participating in and creating my own clinical trials at Gulab Devi. I began assisting in various clinical trials in order to gain a more in-depth understanding of the importance of clinical trials and its eventual application in the real medical world. I feel that this particular opportunity helped me become an even better, more compassionate doctor with my patients both in the hospital and during my volunteer medical missions. Preet Hospital I wound up serving my country as the Medical Officer at the Preet Hospital which is also in Jalandhar, India from May 2007 to October 2009.The job I had there required my personal supervision of the clinical documents of the patients discharged or admitted from the emergency department. It was of the utmost importance that these clinical documents were on the level and followed the medical protocol set by the department of health and our hospital. The inspection that I did of the documents were meant to help our hospital avoid and potential malpractice suits. I also helped provide an effective platform of communication pertaining to referrals and liaisons between the hospital staffers in order to insure the proper treatment of patients. Having begun to develop a keen interest in internal medicine and I took on cases that doctors did not want to handle because they were interested in a specialized illness. I was interested in all medical cases pertaining to human organs. No exceptions. That is why I feel that I learned a lot during my time of work in India. Take for instance the case of this particular patient who came to my clinic. She had a history of heartburn and indigestion and took aspirin as part of her doctor prescribed blood thinning regimen. She was brought to the hospital by concerned relatives after the discovered her passed out in the house where she lived alone. I was immediately concerned after hearing that she was taking regular doses of aspirin tablets while also suffering from heartburn and indigestion. As any medical practitioner knows, aspirin is one of the primary causes of intestinal bleeding among the elderly. As I further spoke with the patient, I came to understand that after a number of weeks on the aspirin regimen, she began to feel weak and experienced shortness of breath. I took great pains to question her about the situation that led to her passing out in a very calm, caring, and warm manner. It was then that she explained that she passed out after having excreted black, tarry stool. A Black starry stool is often associated with bleeding ulcers. But I needed to be sure. Luckily, Preet Hospital had just purchased an excellent endoscopy diagnostic machine and she was one of the first people who experienced a technologically advanced diagnosis from it. I did not waste any time in ordering that the inspection on her digestive system be performed. The tests confirmed what I already suspected. She was suffering from bleeding ulcers and I immediately set out to treat it with the proper IPP blockers (Nexium) and antibiotics (Amoxycillin) alongside aspirin tablets to prevent infection and fever from setting in while we dealt with the bleeding ulcers. This I felt, was the best way to give her intestinal walls time to heal on its own. During certain instances, I also found myself tasked with the duty of organizing, managing, and participating in daily activities meant to enhance patient participation in their treatments. Through these doctor-patient collaborations, I always encouraged the doctors to maintain a close relationship with their patients. Their interest must be felt as an earnest interest which could be either visibly seen or felt by the patient during the course of treatment and even after their discharge if necessary. Government Subsidiary Health Center The last hospital job I held in India was that of a Medical Officer I/c at the Government Subsidiary Health Center in Punjab, India. I was stationed at the Out Patient Department and Referral Center from October 2009 to April 2011. It was in this clinical setting where I learned to merge the administrative side of running a health care institution alongside my duties to the patient as their immediate care physician. I could be signing off on important hospital administrative documents one moment and then getting ready to assist in an emergency operation the next minute. I oversaw the work of the emergency room physicians and made sure that they always met the international healthcare standards of patient care regardless of the financial status, religious belief, and social standing of the patient in their care. It was during my stint at this hospital that I encountered a an internal medicine case that truly left me boggled for a number of days. A young lady who worked at a local call center came in to my clinic complaining of severe chest pains and difficulty in swallowing and breathing. She was worried that she was on the verge of suffering a heart attack due to the stress of her job and long hours at work. Since her symptoms pointed towards the possibility of the existence of a heart disease, I decided to confirm the diagnosis by ordering a series of cardiac tests in order to prove the current condition of her heart. Two days later the woman was back at the hospital where I ordered that a blood test for cholesterol, uric acid, and the like be performed on her. Additionally, I scheduled her for an ECG and treadmill stress test to test for other symptoms of heart disease. Her blood test showed normal levels of cholesterol, and others. A blood pressure check showed that she was within the normal blood pressure range for her age group which was between 20 to 40 years old. Her ECG tests did not show any signs of abnormality in the heart function either. Her last test result that came out was her stress test. For this particular test, I had her begin slow jogging on the medical treadmill for the first fifteen minutes, with the speed progressing as the technicians deemed fit. It turned out that the young lady was a regular gym habitue and running on a treadmill was part of her regular exercise regimen. Thus the final test actually negated the possibility of a cardiac illness for the patient. Delving deeper into the problem, I decided to interview the patient about her job situation, hoping that it would perhaps hold a clue as to what might be causing her illness. I was beginning to suspect that the illness could only be psychological and not actually physical, in which case I would have to refer her to the proper medical professional within the hospital. I discovered that this particular patient was assigned to take over seas client calls at her call center agency. Their volume of calls amounted to about 150 calls a day for each agent. Which meant that she had to handle close to 10 calls per hour in order to meet her quota for the day. Oftentimes, she would miss out on her coffee break and lunch break due to the heavy volume of calls. That was my first clue towards the possibility that the patient was suffering a Gastric ailment more than anything else. Skipping meals often time causes acid reflux in most people due to the lack of food in the system and the build up of acids meant to help digest the food that should be in our digestive tracts at specific hours. However, this young lady was missing out on meals at least twice a day. Working in India meant that her clients overseas were awake when it was evening in India. Therefore she slept through the hours when our body needs to be awake and taking in food for breakfast and lunch. She was basically eating only one meal a day, dinner. I analyzed her symptoms very well and came to the conclusion that what we thought were symptoms of a heart attack could possibly be symptoms of severe heartburn instead. But heartburn of this magnitude was not something that I was used to seeing in my patient room. It was then that I developed a possible diagnosis for the patient. I decided to order an endoscopy procedure to be done on the patient in order to see the actual status of her gastro intestinal tract. This was the test that confirmed my suspicions. Her Esophagus was severely inflamed and there was an abnormally high concentration of acid in her esophageal tract. Further diagnosis showed that her lower esophageal tract was no longer properly sealing off the esophagus and stomach areas for proper digestion. Acid was seeping through the weakened sphincter and causing the increased chest pains that the patient was feeling. All the results of the endoscopic exam proved with finality that the patient was suffering from Gastro Esphageal Reflux Disease. I immediately set her out on a 2 week regimen of IPP blockers in order to regulate the acidity in the stomach. I also gave her a medical certificate requesting her office to allow her to take leave for 3 months in order to give her body enough time to heal from the ordeal that it had just undergone. The patient needed to understand that her illness was not going to go away with simple medication. I made sure that she understood that GERD, as it is more commonly known, required a lifestyle change on her part. She could no longer wear binding clothes that could apply pressure to her stomach area and force acid back up the esophageal tract, she had to avoid the so called “trigger” foods (cream based, sauce based, sour, or spicy foods), and most of all she had to eat her full meal on time every time. Sure she had medications that I prescribed which would help alleviate her situation. But unless she followed my instructions to the letter, she would never be able to manage her illness. It was with great pride that I found out a year later that the young lady I diagnosed had followed all of my medical advise and now led an almost GERD free lifestyle as heeding my medical advise helped control her illness. I also participated in hands on patient care due to the lack of medical doctors on the floor. I also participated in further developing the walk in patient, out-patient, and charitable outreach programs that further benefited the immediate community that we serviced and helped improve doctor patient relationships with the townsfolk since the doctors were now seen more as family friends who actually cared for their health and well-being rather than just being an unknown and straightforward physician to them. I also worked towards getting solid financial support for the modernization of our health care facilities. I offered solutions that could help in enhancing our patient care abilities and allowed us to hire the most competent physicians that we could based upon yearly budget. Read More